Managed Care Plans Analyze How the Policies Essay

Download this Essay in word format (.doc)

Note: Sample below may appear distorted but all corresponding word document files contain proper formatting

Excerpt from Essay:

Managed Care Plans

Analyze how the policies and practices related to Managed Care Plans can influence the activities of managers in health services organizations.

Over the last several years, the role of health care organizations has been continually evolving. Part of the reason for this, is because costs have been rising exponentially. Evidence of this can be seen with a survey that was conducted by the Kaiser Foundation. They determined that over the course of one year, health insurance premiums have increased by 14%. This is a part of a larger effort, to deal with rising costs at a variety of health care organizations. (Ableson, 2010)

As a result, a shift has occurred in the kinds of services that are being provided to consumers. This has lead to a transformation in the policies and procedures at managed care plans. To fully comprehend how these shifts are occurring requires examining: the different ways they can have an impact on activities of managers of health services organizations (HSO's). This will be accomplished by: defining managed care, looking at why no single definition can apply, analyzing five major participants, studying how participants can influence managers and discussing the way these concepts can be used in an interview with an HSO manager. Together, these different elements will provide the greatest insight as to the overall influences of managed care plans on the activities of HSOs.

Define Managed Care

Managed care is when you are controlling the costs associated with the delivery of health care services through the primary care doctor. They are known as the gatekeeper, who will only refer patients to those services that are the most expensive, when they are absolutely necessary. To include: the use of specialists, physical therapy and various types of surgery. ("Definition Managed Care," 2011) This is important, because it is showing how managed care organizations are focused on increasing their profit margins and reducing costs as much possible.

Explain why there is no one single definition that accurately describes all forms of Managed Care.

The reason why, there is no single definition is because once you move beyond the basic description, the kinds of services and organizations are different. This is due to the fact that many will sub-divide based upon the treatment options they are providing. A few of the most notable include: HSOs, preferred provider organizations and point of service organizations just to name a few. This is significant, because it is illustrating why, there is no single definition that can be applied to managed care. As the areas of specialization and the kinds of customers that they are serving will vary from: one entity to the next. (Duncan, 1997, pp. 24 -- 30)

Analyze the 5 major participants that are involved in each Managed Care arrangement.

The five major participants that are involved in the managed care arrangement include: the patient, the health care provider, the managed care organization, regulators and shareholders. The patients are paying the premiums into the plan. Their objectives are: to find lowest costs possible and receive the highest quality services. The health care provider is delivering these services to patients. Their motivation is to: control the costs of supplying these services and increase their profit margins. The managed care organizations are trying control the costs that they are paying for health care services and increase their bottom line results. The regulators are concerned about if various health organizations following the law. Their main objectives are to: help control costs and make certain that the public is being treated fairly. The shareholders are interested in seeing their total returns rise. This means that they will place pressure on management to: control costs and increase their earnings as much as possible. (Duncan, 1997, pp. 24-30)

Explain how these participants can influence the role / functions / activities of managers in HSOs.

The patients can have an impact on HSO managers by: demanding that they begin receiving certain kinds of services. This will lead to shift in how managers are looking at: the way they are delivering various kinds of health care solutions to them. At which point, a change will take place in the organization's policies and procedures. This will have an impact on how managers are performing their jobs and the kind of activities they are allowed to engage in. (Feeny, 1986, pp. 47- 52) (Beam, 2005, pp. 69 -- 73)

The health care providers will have an influence on HSO managers based on the costs that they are charging for different services. This will force many executive to begin implementing strategies to control costs as much as possible. As this is impacting how they are performing their jobs and the kind of actions they are taking. Over the course of time, this will change how these individuals are performing their different duties and what areas they will focus on. (Feeny, 1986, pp. 47- 52) (Beam, 2005, pp. 69 -- 73)

The managed care organization will have effect on HSO mangers through: their attempts to control costs and limit access to expensive services (i.e. specialists). This will influence executives by causing them to embrace policies and procedures that could be similar. As, the HSO may have different customers and are offering contrasting services, yet the techniques that they are using to increase profits as well as control costs are what will influence these managers. Where, they are utilizing similar tactics to help their organization to achieve the same kinds of goals. This is influencing how they will view their roles and the actions they are taking in the organization. (Feeny, 1986, pp. 47- 52) (Beam, 2005, pp. 69 -- 73)

Regulators will influence managers by: forcing them to follow various provisions of the law and new changes that are being implemented. This will have an immediate impact on the ethical and legal responsibilities for these executives. At the same time, it will shape what kind of actions: the organization is taking and the type of relationship that managers will have with customers. (Feeny, 1986, pp. 47- 52) (Beam, 2005, pp. 69 -- 73)

Shareholders will have an impact on managers by placing pressure on the board of directors to increase the returns of the organization. They will encourage executives to enact in policies and practices that will help to improve the overall bottom line results. Over the course of time, this will influence the way these individuals are: performing their jobs and determining what areas are of most importance to them. (Feeny, 1986, pp. 47- 52) (Beam, 2005, pp. 69 -- 73)

These different elements are significant because, they are showing how there are a number of variables that will affect managers. Each one of them will work as a part of: the how the individual is viewing their responsibilities and what actions they are taking on a daily basis. As a result, the combination of them will affect the duties and the kinds of policies that are enacted at the organization. (Feeny, 1986, pp. 47- 52) (Beam, 2005, pp. 69 -- 73)

Explain how you can apply the concepts / materials / related to Managed Care to your interviews with your manager in an HSO.

These concepts could be applied to an interview by helping us to understand the kinds of challenges that HSO managers are dealings with. This is important, because knowing how these factors can influence them and the way their thinking will provide insights about their jobs. Where, they must serve as a go between for: the different interests and challenges that the organization is facing. As, they are expected to: maintain a fine balance between the various sides. The issue is ensuring that neither one of these participants gains to much influence over the manager.

As a result, understanding these concepts will help to create focused questions that will allow us to: understand the responsibilities, activities, functions and how they are changing in the future. This leads us to several questions that will be asked as a part of the interview. A few of the most notable include:

How do patients, health care providers, managed care organizations, regulators and shareholders influence the kinds of policies and practices of the company?

Which one of these different groups has the most influence on your organization? Why?

What are the biggest challenges that you are facing now and in the future?

Do you think that there is a particular group that will influence your organization in the future?

How have you been dealing with the various challenges your company has been facing?

In what ways, do these challenges and participants influence your positions and the kinds of activities you are engaged in?

These questions are important, because they will help us during the interview to understand what issues are influencing managers the most. This is the point that we can be able to know how these concepts and material can provide a real world perspective of these challenges. Once this occurs, our interview will be focused on aspects…[continue]

Cite This Essay:

"Managed Care Plans Analyze How The Policies" (2011, June 11) Retrieved December 3, 2016, from

"Managed Care Plans Analyze How The Policies" 11 June 2011. Web.3 December. 2016. <>

"Managed Care Plans Analyze How The Policies", 11 June 2011, Accessed.3 December. 2016,

Other Documents Pertaining To This Topic

  • Managed Care Situation Such as

    These skills are vital for them to make an impact, considering the powerful relationship between leadership strength and influence. (...) In Australia the following study has noted a change in skill mix may be necessary: Rising demand for health services, cost containment and shortages of nurses, midwives and other health workers were cited as the major catalyst for skill mix changes by ICN (2005d in ICN 2006). ICN (2004 in ICN

  • Policy and Practice in Social

    Programs and Services § Briefly describe the major programs and services, and the population intended to be served. Before choosing the programs it is pointed out that about three decades ago, the term 'organizational culture', came in vogue. It resulted in a study of the different styles of organizing. Today the organizational change can be achieved easily and the methods of conducting programs themselves can be a part of a project that

  • Charity Patients When Healthcare Is Limited Treating

    Charity Patients WHEN HEALTHCARE IS LIMITED Treating Charity Patients Charity or uninsured patients do not receive adequate health care. They cannot afford it as hospitals charge them to four times more than those with healthcare coverage (The Associated Press, 2004). Hospitals explain that the steep charges are meant to cover the increasing costs of indigent care. These patients who are already financially crippled are furthermore subjected to aggressive debt collectors. About 43 million

  • Health Care Facility Managing a

    What emerges from these efforts are two essential understandings. First, in spite of whatever evidence may exist to the contrary, system building will continue apace in the hospital industry. Whether the battlefield is risky is immaterial, for the battle is joined. Some individual hospitals may decide to remain solo or stay in modest-sized systems where problems are more manageable, at least until some future time when some of the cloud

  • Planned Change in a Department Change Within

    Planned Change in a Department Change within the Medical surgery department There are various factors that occasion change within any organization, some may be due to change in the operations of an organization, some due to expansion, relocation, takeovers, mergers, external forces in economies, internal changes in operation modes or even unprecedented needs as unforeseen at the initial stages. This last one seems to be case within the medical surgery unit in

  • Policy Analysis IT Policy Thailand

    Furthermore it was a challenge for the government to provide computers and other equipments at large level (Thaichayapong, 1997) Similarly Russell Pipe who was the Deputy Director of Global Informaiton Infrastructure Commission also criticized the policy saying that there were many risks involved in spreading IT facility and also that the expectations are high. He also stated that IT policy 2000 aims to provide TI facilities all through the country

  • Financial Planning in Health Care Organizations 1

    Financial Planning in Health Care Organizations [1: Please note that all sources and facts utilized in this paper are from the customer provided reading material.] Healthcare is on everybody's mind today. From the insurance debate in Congress to our own personal worries about dental or medical insurance and how we can obtain it at a low price, healthcare is not only widely discussed in our society, but it is necessary to

Read Full Essay
Copyright 2016 . All Rights Reserved